Implanon
A form of contraception where a soft vinyl polymer rod impregnated with a hormonal progestagen (etonogestrel) is inserted under the skin of the upper arm. The hormone is slowly released over three years. This inhibits ovulation and simultaneously alters the cervical mucus making it impregnable to sperm.
Inflammation
A defence process where tissues become; red from enlargement of blood vessels; swollen from an increase of tissue fluid and painful from the release of messenger chemicals that stimulate pain nerves in the area. Bacteria or damaged tissue stimulate the “inflammatory response” which is orchestrated by nearby white blood cells. These cells release inflammatory proteins which attract other white blood cells that can destroy bacteria and damaged cells. Another type of white blood cell called a fibroblast can lay down fibrin forming scar tissue.
Auto-immune disease is where the body spontaneously produces the inflammatory response inappropriately against the bodies own tissues.
Interception
The method of preventing pregnancy after fertilization but before implantation of the fertilized egg.
- Insertion of an IUCD within five days of coitus. Implantation is not likely before this time. This is the most reliable form of interception. In cases of rape where a pregnancy would not be terminated if it occurred, this method should be offered.
- “Morning after pill” – The administration of hormones over the one to two days after coitus. A commonly used but highly unreliable method. Of patients who are vulnerable the method is only likely to be effective if the LH surge responsible for inducing ovulation mid cycle has not yet occurred. The bolus of hormones will postpone the LH surge and hence reduce the chance of pregnancy. Without hormonal testing it is not possible to determine this. The method is not recommended.
- Administration of RU 487 – This is an anti-progesterone drug which substantially reduces the receptivity of the endometrium to the fertilized egg. Not readily available in Australia or the USA.
Intraepithelial
Contained within the epithelium i.e. the surface layer of skin or mucous membranes. The epithelium is separated from the deeper layers of the skin or mucous membrane by the basement membrane. Precancers of the cervix and skin are cofined to this epithelial layer and do not breach the basement membrane. See microinvasive carcinoma.
Introitus
The entrance to the vagina. The vestibule.
IUCD
Intra Uterine Contraceptive Device (see Contraception)
IVF (In-Vitro Fertilization)
An infertility treatment where a woman’s eggs are harvested, under ultrasound vision, by puncturing ovarian follicles. This is usually after ovarian stimulation where hormones are administered to the woman over several weeks to increase the number of eggs for harvest and fertilization. The eggs are fertilized in a petrie dish by sperm obtained from the male partner or donor. The resulting embryos are carefully monitored by embryologists and either implanted several days later or stored by freezing for later use.
LETZ (Loop Excision of the Transformation Zone)
A gynaecologic procedure where a wire loop heated by an electric current is used to excise a button of tissue from the cervix. This is a common way to biopsy and/or treat CIN.
Libido
Sexual appatite – desire for sex. Originates from stimuli in an area of the hypothalamus in the brain. This area is ten times larger in males than in females!
Menarche
The age when periods start.
Menopause
Menopause is the whole lifetime of a woman after the cessation of menstruation. It is deemed to have begun when there have been no periods for 12 months.
The presence of symptoms is variable. Approximately 30% of women have no or minimal effects. Some have moderate symptoms and in 20% to 30 % the symptoms can be debilitating. In some women symptoms if they occur at all may only last a few weeks or months, in others they continue for years, whereas in a few the symptoms persist for the rest of their lives.
The average age of menoause is 52 years. 10% of women still menstruate at 54 years of age and some stop as late as 58 years old. Premature Menopause occurs before the age of 40 years.
For women who have had their ovaries surgically removed menopause is immediate (ie symptoms usually would occur in a previously menstruating woman within three days).
The perimenopause is when ovulations fail to occur frequently (i.e. less than 50% of the time) on a monthly basis. It may start at any time in “reproductive life” but commonly develops after 45 years of age and may continue for up to ten years.
As ovulations are irregular the woman may feel normal during an ovulatory interval, then become menopausal if a follicle fails to develop after menstruation. Follicles release estrogen. Lack of estrogen causes menopausal syptoms. In the situation where the follicle develops but does not ovulate progesterone production may not occur resulting in estrogen excess. This can cause sore breasts, excessive emotional responses with irritability or an abnormal ease in weeping.
Menorrhagia
(also see Endometrium)
Heavy periods. During the days of maximum bleeding for a normal period protection would need to be changed no more than every 4 hours. The length of bleeding ranges from one to seven days with the largest flow only lasting one to three days. Bleeding in excess of the above is abnormal. The passing of clots is also an indication of heavy loss.
Menorrhagia is important to treat not only because it may lead to debilitating anaemia and the many consequences of that but also there may be dangerous pathology causing the problem. Many causes such as polyps are easily treated while others include fibroids, adenomyosis, intrauterine infections, bleeding diseases and neoplasms (pre-cancers and cancers).
Metaplasia
A biologic process where an epithelium of one type changes to a different type. 80% of girls after menarche will have ectopies (patches of glandular columnar skin) on their cervices. During their life-times metaplasia occurs resulting in squamous skin replacing the previous ectopy. The area where this replacement has occurred is called the transformation zone. If HPV is present in the vagina when metaplasia is occurring the viral genome may become incorporated into that of the cervical cells resulting in transformation of that tissue into CIN. The presence of sperm in the vagina increases the susceptibility of the cervical cells to the egress of the virus into them. The acrosome head of the sperm contains basic proteins (protamines and histones) which are released into the vagina when the sperm disintegrate. The ratios of these proteins in the sperm swarms of men vary depending on their genetic make-up. The more basic the proteins released the greater the susceptibility of the cervical cells. It has been demonstrated in epidemiologic studies that some men pose a greater risk to their partners than others. See Dr Bevan Reid’s chapter in Gynaecologic Oncology Edited by Malcolm Coppleson Second Edition Vol 1 Chapter 5 p 96-99
Metastasis
The development of secondary malignant growths at a distance from the primary site of a cancer.
Mutations
The changes in the structure of a gene, resulting in a variant form that may be transmitted to subsequent generations. They are caused by an alteration of the chemistry of the DNA, or the deletion, insertion, or rearrangement of larger sections of genes or chromosomes.
Microinvasive Carcinoma
(see intraepithelial neoplasia)
The earliest stage of cancer where the basement membrane has been breached by a formerly precancerous neoplasm. Microinvasive carcinomas are invariably curable.
Mucous Membrane
The covering of internal organ cavities and surfaces. They produce mucus and secretions for lubrication, digestive or protective functions.
Myoma
(see Fibroid)